How to convince key decisionmakers to integrate health literacyChristopher Trudeau
Looking to make the business & regulatory case for integrating health literacy or patient-centered care into your hospital or health system. This presentation gives practical tips and example slides I've used to help make the case.
Managed Care within Health Care covers a variety of information from nursing homes, policies, Medical, Medicare, out of pocket, and partial payment, management, contracts, government, and the Social Security State Fund. Within this working paper I will discuss a few of these mechanisms that are applied and utilized within ‘Managed Care’ today. A system within a system that brings in 25% of the United States debt.
How to convince key decisionmakers to integrate health literacyChristopher Trudeau
Looking to make the business & regulatory case for integrating health literacy or patient-centered care into your hospital or health system. This presentation gives practical tips and example slides I've used to help make the case.
Managed Care within Health Care covers a variety of information from nursing homes, policies, Medical, Medicare, out of pocket, and partial payment, management, contracts, government, and the Social Security State Fund. Within this working paper I will discuss a few of these mechanisms that are applied and utilized within ‘Managed Care’ today. A system within a system that brings in 25% of the United States debt.
Introduction
The big business of health care is growing in a massive rate more now than ever according to The Center for Health Workforce Studies a non-profit organization located in Rensselaer, New York the organization report that, “While total U.S. employment dropped by over 2% between 2000 and 2010, health care employment grew by more than 25% during the same period. More than 13% of the U.S. labor force worked in the health sector or in a health occupation (19 million jobs out of 143 million jobs in U.S. labor force). The health care sector is projected to add over 4.2 million jobs between 2010 and 2020, with 63% of those in ambulatory settings (offices of health practitioners, home health, and other non-institutional settings” (2012, CHWS). Health care is booming in all areas of study and research from Holistic to Western Medicine which include purchasing and supply. Unfortunately this is based off the demand for more Physicians that are not available where there is a need. The health care industry believe it or not includes the food industry and health and fitness as well.
The matter of ethics within the health care industry always needs to be address along with the quality of care for patients. Within this working essay paper I will discuss the matter of; Care & Service Provider, Ethics (codes and values), Mal-Distribution Physician Labor Forces. Even though the health care industry is growing the mal-distribution of health care is still evident in some rural areas. This factor of not having proper care delivered to impoverish neighborhoods and communities is another issue that still plagues the United States. David Cutler the online journal reporter for PBS News Hour stated, “About 10, 15 percent. Just to give you one example, Duke University Hospital has 900 hospital beds and 1,300 billing clerks. The typical Canadian hospital has a handful of billing clerks. Single-payer systems have fewer administrative needs. That’s not to say they’re better, but that’s just on one dimension that they clearly cost less. What a lot of those people are doing in America is they are figuring out how to bill different insurers for different systems, figuring out how to collect money from people, all of that sort of stuff” (2013). The need for health care workers is great, but the balance is off regarding where the needs are not being meet.
Clinician’s Research Digest, An APA Journal – Supplemental Bulletin 39, “Improving Access to Behavioral Healthcare Services: The Georgia Crisis & Access Line,” part of a series on research-informed day-to-day clinical practice.
The system of delivery within health care has always been on the change and rise due
to technology along with self-care, health care, development, education, and creating a healthy society. As the old saying goes, “where there is good health there is also good financial wealth” and this is where the formation of the ACA took place and a new integrated delivery system created.
Past President Franklin Roosevelt and Lyndon B. Johnson enacted ACTS and legislation to help the United States Poor to ensure they has proper health care insurance. “The Social Security Act was passed by Congress as part of President Roosevelt’s Second New Deal agenda. In signing the Act into law on August 14, 1935, Roosevelt became the first president to advocate for and create legislation for the provision of governmental assistance for the elderly at the federal level” (CSU, 2015). Considering the new policies and new developments of the country to ensure that housing, food, and work was also available. Time was surely of the essence considering it was the turn of the century and the United States was implementing new changes and programs within the United States.
Introduction
The big business of health care is growing in a massive rate more now than ever according to The Center for Health Workforce Studies a non-profit organization located in Rensselaer, New York the organization report that, “While total U.S. employment dropped by over 2% between 2000 and 2010, health care employment grew by more than 25% during the same period. More than 13% of the U.S. labor force worked in the health sector or in a health occupation (19 million jobs out of 143 million jobs in U.S. labor force). The health care sector is projected to add over 4.2 million jobs between 2010 and 2020, with 63% of those in ambulatory settings (offices of health practitioners, home health, and other non-institutional settings” (2012, CHWS). Health care is booming in all areas of study and research from Holistic to Western Medicine which include purchasing and supply. Unfortunately this is based off the demand for more Physicians that are not available where there is a need. The health care industry believe it or not includes the food industry and health and fitness as well.
The matter of ethics within the health care industry always needs to be address along with the quality of care for patients. Within this working essay paper I will discuss the matter of; Care & Service Provider, Ethics (codes and values), Mal-Distribution Physician Labor Forces. Even though the health care industry is growing the mal-distribution of health care is still evident in some rural areas. This factor of not having proper care delivered to impoverish neighborhoods and communities is another issue that still plagues the United States. David Cutler the online journal reporter for PBS News Hour stated, “About 10, 15 percent. Just to give you one example, Duke University Hospital has 900 hospital beds and 1,300 billing clerks. The typical Canadian hospital has a handful of billing clerks. Single-payer systems have fewer administrative needs. That’s not to say they’re better, but that’s just on one dimension that they clearly cost less. What a lot of those people are doing in America is they are figuring out how to bill different insurers for different systems, figuring out how to collect money from people, all of that sort of stuff” (2013). The need for health care workers is great, but the balance is off regarding where the needs are not being meet.
Clinician’s Research Digest, An APA Journal – Supplemental Bulletin 39, “Improving Access to Behavioral Healthcare Services: The Georgia Crisis & Access Line,” part of a series on research-informed day-to-day clinical practice.
The system of delivery within health care has always been on the change and rise due
to technology along with self-care, health care, development, education, and creating a healthy society. As the old saying goes, “where there is good health there is also good financial wealth” and this is where the formation of the ACA took place and a new integrated delivery system created.
Past President Franklin Roosevelt and Lyndon B. Johnson enacted ACTS and legislation to help the United States Poor to ensure they has proper health care insurance. “The Social Security Act was passed by Congress as part of President Roosevelt’s Second New Deal agenda. In signing the Act into law on August 14, 1935, Roosevelt became the first president to advocate for and create legislation for the provision of governmental assistance for the elderly at the federal level” (CSU, 2015). Considering the new policies and new developments of the country to ensure that housing, food, and work was also available. Time was surely of the essence considering it was the turn of the century and the United States was implementing new changes and programs within the United States.
Where to start when creating a digital marketing plan - 2016Zeeland Family
Presentation to Aalto University students in Masters in Global Marketing Management program. Aim to give them the basis to for the digital marketing plan they need to create as part of the program.
Respond to at least two classmates who identified different areas of.docxpeggyd2
Respond to at least two classmates who identified different areas of disparity than your own. Do you agree or disagree with their assessment of the impact of economic policy on the disparity? Does the disparity discussed have a microeconomic or a macroeconomic impact on health care?
Post # 1
Trina Cox
Disparity in healthcare can be defined as, “differences between groups in health insurance coverage, access to and use of care, and quality of care” (Orger & Artiga, 2018). There are various healthcare disparities; however, the key areas of disparity I have chosen to identify and analyze include health insurance coverage, quality of care, and gender. As most people already know, health insurance is a type of insurance coverage that is designed to cover an insured person’s medical expenses (such as hospital, doctor, laboratory and pharmacy services). Although the number of uninsured Americans have decreased drastically since the passing of ACA, disparities in this area still exist. Some individuals’ annual incomes still are not enough to pay the low premiums that may be required of them to have access to health insurance coverage.
Quality of care can be described as, “the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (AHRQ, 2017). Although it is an unethical act displayed by healthcare professionals; in some areas, all patients are not treated equally with regards to quality of care. According to Dr. Ananya Mandal (2019), discrimination occurs when healthcare providers treat individuals from certain population groups differently to other population groups, whether this is done consciously or not. It is common for this to occur when providers have stereotyped impressions of specific racial or ethnic groups.
Gender can play a major role in healthcare disparities among women, specifically, in some of the developed countries. Researchers have reported that determinants of gender differences, like welfare indicators (e.g., education and income), behavioral factors (e.g., smoking and drinking), and social factors (e.g., social support and socioeconomic status) have direct correlations with some of the existing disparities (Hassanzadeh, et al, 2017). Afghanistan is a country that still has a high rate of gender disparities among women, even though some improvements have occurred. In this country, the biggest disparities that I feel still exist are between women in rural versus urban areas, and those with some education, as opposed to those women with none; showing that as education of women increases, so does their health and that of their children because of the education and resources that they have.
I think several economic policies have impacted these disparities and they include differences in income levels, education, and geographic location. A person’s annual income may have a direct effect on his or her ability.
ORIGINAL PAPER‘‘They Treat you a Different Way’’ Public I.docxvannagoforth
ORIGINAL PAPER
‘‘They Treat you a Different Way:’’ Public Insurance,
Stigma, and the Challenge to Quality Health Care
Anna C. Martinez-Hume1 • Allison M. Baker2 •
Hannah S. Bell
1
• Isabel Montemayor
3
•
Kristan Elwell4 • Linda M. Hunt1
Published online: 26 December 2016
� Springer Science+Business Media New York 2016
Abstract Under the Affordable Care Act, Medicaid Expansion programs are
extending Medicaid eligibility and increasing access to care. However, stigma
associated with public insurance coverage may importantly affect the nature and
content of the health care beneficiaries receive. In this paper, we examine the health
care stigma experiences described by a group of low-income public insurance
beneficiaries. They perceive stigma as manifest in poor quality care and negative
interpersonal interactions in the health care setting. Using an intersectional
approach, we found that the stigma of public insurance was compounded with other
sources of stigma including socioeconomic status, race, gender, and illness status.
Experiences of stigma had important implications for how subjects evaluated the
quality of care, their decisions impacting continuity of care, and their reported
ability to access health care. We argue that stigma challenges the quality of care
provided under public insurance and is thus a public health issue that should be
addressed in Medicaid policy.
Keywords Stigma � Insurance � Poverty � Healthcare � Medicaid �
Intersectionality
& Linda M. Hunt
[email protected]
1
Department of Anthropology, Michigan State University, 355 Baker Hall, 655 Auditorium
Drive, East Lansing, MI 48824, USA
2
Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Avenue,
Boston, MA 02115, USA
3
Department of Sociology and Anthropology, University of Texas at Arlington, 430 University
Hall, 601 S. Nedderman Drive, Arlington, TX 76019, USA
4
Center for Health Equity Research, Northern Arizona University, 1100 S. Beaver St., Flagstaff,
AZ 86011, USA
123
Cult Med Psychiatry (2017) 41:161–180
DOI 10.1007/s11013-016-9513-8
http://orcid.org/0000-0002-1214-8569
http://crossmark.crossref.org/dialog/?doi=10.1007/s11013-016-9513-8&domain=pdf
http://crossmark.crossref.org/dialog/?doi=10.1007/s11013-016-9513-8&domain=pdf
Introduction
A key feature of the Affordable Care Act is Medicaid Expansion, which extends
Medicaid eligibility to many low-income adults with the goal of improving health
equity through increased access to care. While addressing an urgent public health
need, issues within the social context of public insurance may diminish the success
of such programs in effectively addressing health disparities. One such concern is
stigma associated with public insurance coverage, including Medicaid and other
state-sponsored programs for the low-income, which may meaningfully affect the
nature and content of health care.
Stigma—the negative experience of stereotyping, labeling, e ...
ORIGINAL PAPER‘‘They Treat you a Different Way’’ Public I.docxhoney690131
ORIGINAL PAPER
‘‘They Treat you a Different Way:’’ Public Insurance,
Stigma, and the Challenge to Quality Health Care
Anna C. Martinez-Hume1 • Allison M. Baker2 •
Hannah S. Bell
1
• Isabel Montemayor
3
•
Kristan Elwell4 • Linda M. Hunt1
Published online: 26 December 2016
� Springer Science+Business Media New York 2016
Abstract Under the Affordable Care Act, Medicaid Expansion programs are
extending Medicaid eligibility and increasing access to care. However, stigma
associated with public insurance coverage may importantly affect the nature and
content of the health care beneficiaries receive. In this paper, we examine the health
care stigma experiences described by a group of low-income public insurance
beneficiaries. They perceive stigma as manifest in poor quality care and negative
interpersonal interactions in the health care setting. Using an intersectional
approach, we found that the stigma of public insurance was compounded with other
sources of stigma including socioeconomic status, race, gender, and illness status.
Experiences of stigma had important implications for how subjects evaluated the
quality of care, their decisions impacting continuity of care, and their reported
ability to access health care. We argue that stigma challenges the quality of care
provided under public insurance and is thus a public health issue that should be
addressed in Medicaid policy.
Keywords Stigma � Insurance � Poverty � Healthcare � Medicaid �
Intersectionality
& Linda M. Hunt
[email protected]
1
Department of Anthropology, Michigan State University, 355 Baker Hall, 655 Auditorium
Drive, East Lansing, MI 48824, USA
2
Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Avenue,
Boston, MA 02115, USA
3
Department of Sociology and Anthropology, University of Texas at Arlington, 430 University
Hall, 601 S. Nedderman Drive, Arlington, TX 76019, USA
4
Center for Health Equity Research, Northern Arizona University, 1100 S. Beaver St., Flagstaff,
AZ 86011, USA
123
Cult Med Psychiatry (2017) 41:161–180
DOI 10.1007/s11013-016-9513-8
http://orcid.org/0000-0002-1214-8569
http://crossmark.crossref.org/dialog/?doi=10.1007/s11013-016-9513-8&domain=pdf
http://crossmark.crossref.org/dialog/?doi=10.1007/s11013-016-9513-8&domain=pdf
Introduction
A key feature of the Affordable Care Act is Medicaid Expansion, which extends
Medicaid eligibility to many low-income adults with the goal of improving health
equity through increased access to care. While addressing an urgent public health
need, issues within the social context of public insurance may diminish the success
of such programs in effectively addressing health disparities. One such concern is
stigma associated with public insurance coverage, including Medicaid and other
state-sponsored programs for the low-income, which may meaningfully affect the
nature and content of health care.
Stigma—the negative experience of stereotyping, labeling, e.
GUEST EDITORIALSocial Work and Implementation of theAffordable Care Ac.docxharrym15
GUEST EDITORIAL
Social Work and Implementation of the Affordable Care Act
Christina M. Andrews, Julie S. Darnell, Timothy D. McBride, and Sarah Gehlert
The Affordable Care Act (ACA) (full title: The Patient Protection and Affordable Care Act) (P.L. 111-148) will generate
sweeping changes in the financing, organization, and accessibility of health and social services in the United States. The expansion of Medicaid and the establishment of state health insurance exchanges (HIEs) will vastly expand insurance access in the United States, with an estimated 30 million Ameri- cans gaining coverage (Banthin et al., 2012). The emphasis on integrated models of care, including patient-centered medical homes and accountable care organizations, introduces new opportunities to improve care coordination, reduce unnecessary service use, and make health care more cost- effective. Realizing these changes relies on the work of many health care professions. In this edi- torial, we make a case for how the social work pro- fession can forge a leadership role in implementing this historic legislation.
SOCIALWORK EXPERTISE AND THE ACA Because the ACA is so bold and ambitious, it is important to consider how the unique skills and knowledge bases of social work and other health care professions align with its objectives and goals. An integrated approach is needed to maximize the ACA’s potential to improve the health of the pop- ulation.
Four central qualities of the social work profes- sion make it uniquely suited to advance a number of the objectives and goals of the ACA. First, social work situates individuals in the social contexts in which they live. Social workers understand that individuals are part of social networks, neighbor- hoods, and communities that influence their health choices and participation in health care. Under- standing these social relationships provides us with
insight into health behaviors and health outcomes that is necessary to achieve population health goals.
Social workers likewise understand the relation- ship between health, education, employment, and other systems that form the nexus from which resources can be drawn to protect, maintain, and restore health. Social workers are familiar with the complex and overlapping systems that must be negotiated to ensure that the social, psychological, and economic needs of individuals and groups are addressed in a way that underscores optimal health. For instance, social workers know how to ensure that patients have what they need from multiple systems upon discharge, that discharge instructions are understood, and that resources are in place to ensure that those instructions can be followed. This knowledge is essential for avoiding unneces- sary readmissions—events subject to financial penalties under the ACA.
In a related sense, social work is guided by an evidence base that is informed by rigorous research within communities and collective wisdom gleaned from over a century of social work p.
You should respond to at least two of your peers by extending- refutin.docxjosee57
You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts.
Post #1
Jenna Horgan
NUR 420
Professor Roberts
January 12, 2023
Who are the clients in Community Health nursing?
Individuals, families, and groups who live in a specific geographic area and may be at risk for health problems or in need of health services are considered clients in community health nursing. People of all ages, from infants to the elderly, as well as those with physical, mental, or social challenges, may be included. The purpose of community health nursing is to promote the health and well-being of the entire community by addressing the health needs of its individual members (Rector & Stanley, 2021). Community health nurses work with clients to identify and address health risks, provide health and wellness education, and connect clients to suitable health services.
What government resources might they be eligible for?
Individuals and families may be eligible for a variety of government resources depending on their circumstances. Some of these resources are intended specifically for people with low incomes or who are experiencing financial hardship, while others are open to anyone who meets certain criteria. Among the resources available to them are (ISPOR, n.d):
1. Medicaid: It is a federal-state partnership program that provides health insurance to low-income individuals and families. Individuals must meet income and asset limits, as well as other requirements, to be eligible.
2. Children's Health Insurance Program (CHIP): It is a federally funded program that provides health insurance to low-income children that are not eligible for Medicaid but cannot afford private health insurance. It provides coverage for a variety of medical services, such as preventive care, doctor visits, hospital stays, and prescription medications. Eligibility is determined by income and family size.
3. Supplemental Nutrition Assistance Program (SNAP): It is also known as food stamps and it provides financial assistance to low-income individuals and families in order for them to purchase food. Income and assets, as well as other factors, determine SNAP eligibility.
4. Temporary Assistance for Needy Families (TANF): This program helps low-income families with children by providing financial assistance as well as other services such as job training and childcare. Income and assets, as well as other factors, determine TANF eligibility.
5. Low Income Home Energy Assistance Program (LIHEAP): It is program funded by the federal government that provides low-income households with financial assistance to help them pay for home energy costs such as heating and cooling. The Department of Health and Human Services (HHS) administers the program, which is intended to assist households that are struggling to pay their energy bills and may face having their service disconnected. Eligibility is determined by income and family size.
What ag.
11 minutes agoJessica Dunne RE Discussion - Week 3COLLAPS.docxdrennanmicah
11 minutes ago
Jessica Dunne
RE: Discussion - Week 3
COLLAPSE
Top of Form
NURS 6050C: Policy and Advocacy for Improving Population Health
INITIAL POST
Economic Challenges of Healthcare Policy
The economics of the healthcare system in the United States is complex and fragmented. Costs associated with care and the prices healthcare consumers pay are determined by a wide variety of factors making it extremely difficult to find a one size fits all solution. Knickman and Kovner (2015) argue that healthcare is neither a commodity or a service, because of the high variabilities in need, cost, and consumption. The United States spends 80% of all healthcare revenue on just 20% of the population. Health insurance can be provided by the government, the private sector, or an employer. Some citizens do not have any form of healthcare coverage. Regardless of type, insurance coverage generally only pays a portion of the total healthcare cost leaving the consumer to pay the remaining balance. Moreover, reimbursement standards differ for facilities and providers. The government reimburses healthcare facilities, such as hospitals a fixed amount per patient, which creates a higher incentive to work efficiently. Healthcare providers, on the other hand, are reimbursed based on a fee for service model, meaning the more services they provide, the more money they are reimbursed (Knickman & Kovner, 2015).
Reindart (2010) maintains the passage of the Affordable Care Act (ACA) created more strain on the system by adding approximately 30 million uninsured Americans to the market. The projected cost to provide such coverage is around 8 billion to 1 trillion dollars over the next decade. However, the estimated expense of healthcare with no legislative intervention is 35 trillion dollars over the next decade (Reindart, 2010). Laureate Education (2012) contends that the human resources required to provide healthcare to an additional 30 million people is another consideration the ACA does not address. The United States is already experiencing staff shortages for key healthcare jobs like nurses and physicians. Additionally, with baby boomers retiring from the workforce and simultaneously needing more healthcare resources as they age will inevitably exacerbate the shortage of providers (Laureate Education, 2012).
Ethical Considerations
It is important to recognize that the private sector often follows the public sector when deciding what services will be covered (Knickman & Kovner, 2015). Therefore, the implications of Medicare deciding not to pay for a drug or service will likely affect the entire population. Stein (2010) asserts that cost should not be a consideration in determining if medications or services will be paid for by Medicare. Nonetheless, that is what happened with Provenge, a vaccine indicated for late stage prostate cancer patients. The drug prolonged the lifespan of patients by about four months. Provenge costs around 93,000 dollars per p.
Chapter 4 Where Do We Want to BePrevious sectionNext sectionWilheminaRossi174
Chapter 4 Where Do We Want to Be?
Previous section
Next section
Chapter 4
Where Do We Want to Be?
Even in a country that lacks an overall, cohesive health policy, it is useful to ask: How unhappy are we with our health care, and what do we want to change? Do not expect consistent responses from the American public. When the nation was debating the Clinton health plan, a number of organizations surveyed the public. Respondents reported they believed that the health care system was in trouble. At the same time, they expressed satisfaction with their own largely employer-financed health care programs. Public support for universal coverage was strong, but individuals did not want to pay higher taxes to support it (Peterson, 1995). An ABC New/Washington Post poll in October 1993 showed the following (Schick, 1995):
• 51% of the public favored the Clinton health plan.
• 59% thought that it was better than the existing system.
• Only 19% thought that their care would get better under it, and 34% thought worse care would result.
• However, 57% were against tax increases to pay for it, whereas 40% would be willing to pay.
The American public also appears to be split over the Patient Protection and Affordable Care Act (ACA) as a whole. Data about opposition to the act can be misleading, with a significant portion of opposition coming from people who believe the ACA did not go far enough. They would prefer a public option, for example, or a single-payer system. Overall, the public is
negative about the individual mandate and the employer mandate, but is much in favor of the insurance changes that have been implemented. People are confused about the insurance exchange provisions of the act as well. An April 2013 tracking poll found that “about half the public says they do not have enough information about the health reform law to understand how it will impact their own family, a share that rises among the uninsured and low-income households” (Kaiser Family Foundation, 2013). The same poll reported that 42% of respondents did not know that the ACA was still the law of the land. Twelve percent believed it had been repealed by Congress, 7% believed it had been overturned by the Supreme Court, and 23% didn’t know whether it was still in effect or not.
Americans report being in good health more than any other OECD country. Their complaints are mostly about financial risks and to some extent access and waiting. A 2010 study of six developed countries showed that Americans were satisfied with their doctors and the availability of effective care, but were also more likely to report that the system needed to be completely rebuilt (Papanicolas, Cylus, & Smith, 2013).
4.1 Alignment with the Rest of Society
Previous section
Next section
4.1 ALIGNMENT WITH THE REST OF SOCIETY
The democratic process is likely to generate many policy experiments as we cope with advancing technology, changing demographics, political pressures, and economic fluctuations. These exper ...
SOCW 6351 Wk 9 Discussion 1. Need Responses.Respond in one of t.docxrosemariebrayshaw
SOCW 6351 Wk 9 Discussion 1. Need Responses.
Respond in one of the following ways:
· Describe two factors that might make minority groups especially vulnerable in the Medicaid policy your colleague cited. Explain why these groups may not have a voice in the policy-making process.
· Offer examples of organized self-help and citizens’ groups as both support mechanisms and potentially powerful lobbies. Describe how these lobbying bodies can help in amending the policy your colleague described.
Support your response with specific references to the resources. Be sure to provide full APA citations for your references.
NA:
Top of Form
Medicaid is a medical assistance program developed specifically for low income individuals of any age, unlike Medicare, which is designed for those over 65 and have no income requirements (“Difference between Medicare and Medicaid”, n.d.). When health care policies are change, they affect programs such as Medicaid and Medicare. For example, when the ACA (Affordable Care Act) was implemented, it led to an increase of enrollment as it made the process easier and reached more individuals and it expanded Medicaid eligibility to low-income adults (Wachino, Artiga & Rudowitz, 2014).
In the state of Pennsylvania, a Medicaid policy that I would amend would be the Healthy PA policy, which was a Medicaid expansion that included drug and alcohol services (IRETA, 2015). The issue is the length of time it takes for someone to be admitted into a program. Whether it’s getting into an inpatient or outpatient program, the process needs to be expedited and more streamlined. Many who are suffering from substance abuse disorders struggle with finally getting themselves into a program and delaying the process could result in someone hesitating and deciding not to move forward with treatment that is crucial (IRETA, 2015).
In Pennsylvania, stakeholders include a steering committee, which is made up of hospitals, health care providers, consumers, foundations and academic institutions (“HIP”, 2019). This committee comes up with ways to improve population health and control health cost including Medicaid and Medicare. They developed a plan for heathcare delivery that will improve the quality of life for everyone, without limitations on income or background (“HIP”, 2019). This committee has 5 work groups that develop implementation plans for the goals that were developed by the committee and focus on specific aspects such as payment, price and quality transparency, population health, healthcare transformation and health information technology (“HIP”, 2019).
References:
HIP stakeholders. (2019). Retrieved from https://www.health.pa.gov/topics/Health-Innovation/Pages/Stakeholders.aspx
IRETA. (2015). Pennsylvania’s Medicaid expansion smooths the road to addiction treatment, but barriers remain. Retrieved from https://ireta.org/resources/pennsylvanias-medicaid-expansion-smooths-the-road-to-addiction-treatment-but-barriers-remain/
Wachino, V., A.
DQ 3-2Integrated health care delivery systems (IDS) was develope.docxelinoraudley582231
DQ 3-2
Integrated health care delivery systems (IDS) was developed to initiate excellence health care access and quality of care to entire populations and community by collaborating and coordinating diverse healthcare professionals. Main driving force of IDS is patient centered care by using resources such as collaborating care from physicians and allied health care professionals to construct continuum of care, to deliver care in the most cost-effective way, utilize trained and competent providers by utilizing evidenced -based practice and combine innovation such as EHR (Electronic Health Records) system and team work to produce improved healthcare system.
Excellence in care is attainable by incorporating allied healthcare professional, as high quality care is possible when coordination is unified and covers all areas of responsibilities. For an example-combining resources and coordination of care by involving physicians, dietitian, physical therapy or occupational therapy to work with patient diagnosed with obesity by promoting teamwork approach and ultimately delivering endurance in care and utilizing various resources.
Barriers to IDS can be a huge block in delivering quality care. Among many one limitation is physicians not participating in integrated healthcare system, which disconnect physicians from team based approached by deterring continuous quality improvement (essentialhospitals.org, n.d). This is because, system such as EHR or new innovative quality assurance programs are time consuming and overwhelming, thus decline in physicians support in IDS programs. By implementing user friendly system approach, enforcing focused based care and accepting the necessity of evidenced based practice can improve these barriers. Hence, increasing clinical expertise to produce better service and quality of care in integrated delivery system.
Essentialhospitls.org (n.d). Retrieved from: http://essentialhospitals.org/wp-content/uploads/2013/12/Integrated-Health-Care-Literature-Review-Webpost-8-22-13-CB.pdf
Dq 3-1
1.
In the US, there is not one type of health care system but rather a subset of systems, some of them catering to specific populations. These subsystems include managed care, military, and vulnerable populations. Managed care is a health care delivery system that seeks to achieve efficiency by integrating the basic functions of health care delivery, employs mechanisms to control utilization of medical services, and determines the price at which the services are purchased and how much the providers get paid, military health care system is available free of charge to active duty military personnel and covers preventative and treatment services that are provided by salaried health care personnel and this system combines public health with medical services, and vulnerable population subsystem offers comprehensive medical and enabling services targeted to the needs of vulnerable populations and government health insurance programs provide.
CHAPTER 1History of the U.S. Healthcare SystemLEARNING OBJECTI.docxmccormicknadine86
CHAPTER 1
History of the U.S. Healthcare System
LEARNING OBJECTIVES
The student will be able to:
■ Describe five milestones of medicine and medical education and their importance to health care.
■ Discuss five milestones of the hospital system and their importance to health care.
■ Identify five milestones of public health and their importance to health care.
■ Describe five milestones of health insurance and their importance to health care.
■ Explain the difference between primary, secondary, and tertiary prevention.
■ Explain the concept of the iron triangle as it applies to health care.
DID YOU KNOW THAT?
■ When the practice of medicine first began, tradesmen such as barbers practiced medicine. They often used the same razor to cut hair as to perform surgery.
■ In 2014, the United States spent 17.5% of the gross domestic product on healthcare spending, which is the highest in the world.
■ As a result of the Affordable Care Act, the number of uninsured is projected to decline to 23 million by 2023.
■ The Centers for Medicare and Medicaid Services predicts national health expenditures will account for over 19% of the U.S. gross domestic product.
■ The United States is the only major country that does not have universal healthcare coverage.
■ In 2002, the Joint Commission issued hospital standards requiring them to inform their patients if their results were not consistent with typical care results.
▶ Introduction
It is important as a healthcare consumer to understand the history of the U.S. healthcare delivery system, how it operates today, who participates in the system, what legal and ethical issues arise as a result of the system, and what problems continue to plague the healthcare system. We are all consumers of health care. Yet, in many instances, we are ignorant of what we are actually purchasing. If we were going to spend $1,000 on an appliance or a flat-screen television, many of us would research the product to determine if what we are purchasing is the best product for us. This same concept should be applied to purchasing healthcare services.
Increasing healthcare consumer awareness will protect you in both the personal and professional aspects of your life. You may decide to pursue a career in health care either as a provider or as an administrator. You may also decide to manage a business where you will have the responsibility of providing health care to your employees. And last, from a personal standpoint, you should have the knowledge from a consumer point of view so you can make informed decisions about what matters most—your health. The federal government agrees with this philosophy.
As the U.S. population’s life expectancy continues to lengthen—increasing the “graying” of the population—the United States will be confronted with more chronic health issues because, as we age, more chronic health conditions develop. The U.S. healthcare system is one of the most expensive systems in the world. According to 2014 statistics, the ...
DSmith_Increasing Health Insurance Literacy in Marketplaces and the Communities They Serve
1. Increasing Health Insurance Literacy in Marketplaces and the Communities They Serve
Page 1 Denise O. Smith
Increasing Health Insurance Literacy in Marketplaces and the Communities They Serve
Denise O. Smith
dsmithcommunityhealth@gmail.com
HSM541
Health Services System
Keller Graduate School of Management
Professor Julie Dennis
June 18, 2016
2. Increasing Health Insurance Literacy in Marketplaces and the Communities They Serve
Page 2 Denise O. Smith
Table of Contents
Background 3
Define the Problem 4
Literature Review 5
Problem Analysis 11
Possible Solutions 13
Solutions and Implementation 16
Justification 18
References 20
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Background
Health insurance marketplaces established through the implementation of the Affordable
Care Act (ACA), have enrolled more than 12.7 million individual United States citizens since
October 2013 (U.S. Department of Health and Human Services, 2016) through annual and
special open enrollment periods. Across the U.S. hundreds of different insurance plans are
offered through the 16 state-based marketplaces and Healthcare.gov, the federal marketplace,
including Medicaid and CHIP, each with unique eligibility requirements, premiums, deductibles,
copays and coinsurance (National Public Radio, 2013).
“Enrolling in a health insurance plan is not a simple task” wrote Laurie Martin for the
Rand Corporation in the early days of the first open enrollment, “Ignoring this complexity and
failing to support people with low health literacy could create barriers” (Martin, 2013).
Enrollment into health insurance requires one to create accounts on an online website,
knowledge of insurance and other state eligibility rules, ability to calculate a Modified Adjusted
Gross Income (MAGI), analyze and compare insurance plan information, and a grasp of
insurance-specific jargon such as premium, subsidy, cost sharing, coinsurance, in-network and
other terms. Navigators and assisters were funded by states and the federal government to aid in
the completion of complicated enrollment processes (Paez, Development of the Health Insurance
Literacy Measure: Conceptualizing and Measuring Consumer Ability to Choose and Use Private
Health Insurance, 2014).
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Lack of health insurance literacy has emerged as the overarching barrier for new
enrollees, and has continued impact on insurance engagement and access to health care post
enrollment resulting in poor system utilization, lack of engagement in prevention services and
“one in five enrollees experiencing gaps in coverage due to lack of premium payments” (Cohn,
2014).
Using reports and peer reviewed research, this paper explores, what issues surround
health insurance literacy and what upstream population level interventions exist to increase the
health insurance literacy of newly insured communities.
Define the Problem
While the ACA seeks to increase access, reduce cost and improve the quality of health
insurance and healthcare (Berwick, 2008), poor health literacy among U.S. adults remains a
formidable foe. Currently “more than 36% of U.S. adults limited health literacy; 22% have basic
and 14% have below basic health literacy. Only 12% of American adults are considered health
literate” (Glassman, 2013). Thus a review of the current approaches to improving health literacy
is key to solving this problem.
The traditional model in the United States is one of agency and asymmetric knowledge,
skills and resources, favoring health insurance brokers or medical practitioners who recommend
or provide services, resulting in consumers “delegating decision making” (Folland, 2010). Low
health literacy, the inability to “obtain, process and understand basic health information and
make appropriate health decisions” (Office of Disease Prevention and Health Promotion, 2008)
contributes to the prevalence and persistence of asymmetric information. This definition of
health literacy centers on the ability of the consumer to operate within a largely clinical or
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medical setting and does not comprehensively address the interrelatedness of health and health
insurance literacy; the focus of this text and the source of enrollment, access and utilization
barriers. “Although health insurance literacy overlaps with health literacy, it is distinguished by
the need to understand how health insurance benefits are structured, and to understand and
estimate cost sharing responsibilities; health insurance literacy is a factor in whether consumer
delay or avoid seeking care due to cost” (Paez, Development of the Health Insurance Literacy
Measure: Conceptualizing and Measuring Consumer Ability to Choose and Use Private Health
Insurance, 2014). Health literacy was found as a contributing factor to low enrollment for youth,
LEP and people of color who are targeted by the ACA marketplaces (Long, 2014).
Early open enrollment consumer assistance programs coordinated by marketplaces and
staffed by navigators and assisters were seen as an acknowledgement of the complexities
inherent in insurance enrollment and reports indicated that “79% of consumers who enrolled
sought out in-person assistance to help demystify health insurance” (Gupta, 2016), however
funding for these consumer programs in the 16 state-based marketplaces was eliminated after the
first year of open enrollment and funding in the other 34 states remains unstable and
continuously debated in the federal legislature (Kern, 2014).
Simultaneous issues emerge in the context of the continued success of enrollment of the
uninsured through the marketplace; who will provide and coordinate health insurance literacy
interventions
Literature Review
Improving health literacy among newly insured adults is an important part of achieving
the triple aim in the Affordable Care Act (Berwick, 2008). In “Attributes of a Health Literate
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Organization” (Brach, 2012), Brach et al explore the health literacy of organizations as indicative
of their ability to increase health literacy among the population they serve. They hypothesize that
there “is an imbalance between the skills of people and the demands of the healthcare system”
and in response to this deficiency, they propose ten attributes that can be used to evaluate the
capacity of organizations to effectively address this issue, including “leadership that makes
literacy an integral part of its mission, integrates health literacy into planning and quality
improvement, meets the needs of populations with a range of health literacy skills and
communicates clearly what health plans cover and what individuals have to pay for” (Brach,
2012). The authors believe their big tent approach to the adoption of these attributes in all
interconnected sectors, healthcare, public and private payers and among adults of diverse
backgrounds, is the most logical way to respond to the system, communication and access
barriers that low health literacy creates.
In “Health Literacy: A Challenge for Nearly Everyone” (Krause, 2008), the CT Health
Foundation (CHF) agrees that, “even those who are highly educated are challenged to understand
and use health information at some point” (Krause, 2008), yet their solution is focused on
providing health literacy through adult education sites, centers and programs. In their research,
six adult education centers received approximately $72,000 to implement health literacy
education study circles, around themes such as health care access and navigation, disease
prevention and screening and chronic disease management, with results after 15 months showing
“students were more comfortable asking questions of their health providers and more confident
managing their health after being exposed to the curriculum” (Krause, 2008).
Integrating health literacy education into adult education can also be found in the work of
Mooney et al in “Addressing the Health Literacy Needs of Adult Education Students” (Mooney,
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2013). This guide deepens the discussion of health literacy, rejecting the limitations of traditional
definitions about an individual’s “capacity to obtain, process and understand” (Office of Disease
Prevention and Health Promotion, 2008) which “defines health literacy as a risk instead of an
asset, ignores social conditions that can limit access to healthcare and does not reflect the
dynamic social practice of health literacy always situated in specific sociocultural settings”
(Mooney, 2013).
This deep understanding of sociocultural impacts on health literacy is well expressed in
“America’s Health Literacy: Why We Need Accessible Health Information” (Office of Disease
Prevention and Health Promotion, 2008) which, although it adopts the traditional definition of
health literacy as the expression of a person’s ability to function in health systems, explores
significant barriers to this functioning in race, culture and income. Data presented in this report
indicate that while all people experience health literacy barriers, “below basic health literacy
measures disproportionately impact Blacks and Hispanics, adults with less education, the elderly
and those receiving insurance coverage through Medicaid” (Office of Disease Prevention and
Health Promotion, 2008).
This report also addresses health literacy as an organizational priority as does Brach, and
urges organizations to “change the way health information is designed and delivered, establish
policy guidelines about information access and design, address health literacy as part of a
disparities initiative and encourage insurers to model these improvements and innovations” in
their organizations (Office of Disease Prevention and Health Promotion, 2008).
Recommendations of the Office of Disease Prevention are supported by Mooney, Brach
et al: each acknowledges the importance of social orientation of health literacy in their work.
Mooney also echoes the CT Health Foundation’s (CHF) approach of health literacy in adult
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education, citing that their research “dramatically affected the health literacy scores of their
students” (Mooney, 2013). Research found in Mooney, Krause et al points to a effectiveness in
group participatory initiatives, such as the CHF study circles based on the work of Harvard
School of Public Health Rima Rudd (Krause, 2008), as important in the exploration of a best
practice for disseminating information, but each report lacks content to address between health
and health insurance literacy barriers experienced newly enrolled adults.
Rudd’s work on “Health Literacy: The Intersection between Skills of Individuals and
Demands of Health Systems” (Rudd, 2008) begins is a valuable framework that will have future
application in health insurance literacy discussions. She presents a mismatch in the skills of a
significant number of American adults demanded from an increasingly complex health care
system, charges healthcare settings to become more literate friendly and advocates for significant
change in the delivery of health information” (Rudd, 2008). Future researchers will use this
mismatch framework to describe health insurance literacy challenges in marketplace enrollment.
Early innovations included transitioning organizations to become health literate which
researchers believed would impact the products and services they provided. “The Health Literacy
Universal Precautions Toolkit” (North Carolina Network Consortium, 2010) is one of the first
products that provides implementation guidance and tools for health serving organizations. It
eliminates assumptions about consumers’ knowledge and adopts universal protocols, policies to
improve written and oral communication, and consumer skills development (North Carolina
Network Consortium, 2010).
In 2014 health insurance literacy came into focus with the research of Paez who surveyed
adults knowledge of health insurance literacy in four domains: knowledge, information seeking,
document literacy and cognitive skills, and found that while “more than half of the people
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surveyed were moderately or very confident in their ability to select a health insurance plan, their
actual knowledge was less” (Paez, A Little Knowledge is a Risky Thing: Wide Gap in What
People Think They Know About Health Insurance and What They Actually Know, 2014), as was
their grasp of calculating cost sharing, understanding how to use health insurance to access care
and knowing what services their insurance covers (Paez, A Little Knowledge is a Risky Thing:
Wide Gap in What People Think They Know About Health Insurance and What They Actually
Know, 2014). Parragh confirmed the findings of Paez in “Health Literacy and Health Insurance
Literacy: Do Consumers Know What They Are Buying?” (Parragh, 2015), stating that insurance
is “becoming more consumer driven, and often includes higher deductibles, shifts financial risk
to the patient, increases the stakes and requires an even more sophisticated understanding of
health insurance” (Parragh, 2015) which a majority of newly insured Americans do not possess.
She recounts data from 2013 in which “51% of Americans did not understand basic health
insurance terms such as premium, deductible and copay, and 47% of people receiving federal
subsidies to help pay their premium did not know what they were getting” (Parragh, 2015). The
report points to several initiatives, including the National Action Plan to Improve Health Literacy
(NPHL).
The NPHL is considered a landmark resource for medical and public health professionals
to inform initiatives nationwide. Released in 2010 just after the Affordable Care Act was signed
into law, this document includes seven goals, many of which align with previously mentioned
authors including “promote changes in healthcare organizations and systems, support and expand
health literacy in adult education, increase the development, implementation and evaluation of
practices and interventions to improve health literacy” (Office of Disease Prevention and Health
Promotion, 2010). For the authors of this important work, it is the responsibility of organizations,
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policy makers and professionals to clearly communicate and increase the capacity of American
adults to take positive actions in their own health (Office of Disease Prevention and Health
Promotion, 2010).
Since open enrollment began, consumers have looked to the health insurance
marketplaces created by the Affordable Care Act to facilitate enrollment and understanding of
health insurance. While enrollment has largely been a success, consumers’ knowledge of how
health insurance works or how to use it to has not increased. A formal measure of health
insurance literacy was published in 2014 in the Journal of Health Communication: International
Perspectives, developed through an extensive literature review process of prior attempts to
measure this literacy were found to be limited and lacking validity and reliability (Paez,
Development of the Health Insurance Literacy Measure: Conceptualizing and Measuring
Consumer Ability to Choose and Use Private Health Insurance, 2014). Building on the earlier
work of Paez et al, these authors confirmed that the “tasks associated with selecting and using
health insurance are complex and require applying knowledge while performing skills that are
interconnected” and that without these skills, “consumers may hesitate to obtain a service
because of their concerns about out-of-pocket costs” (Paez, Development of the Health Insurance
Literacy Measure: Conceptualizing and Measuring Consumer Ability to Choose and Use Private
Health Insurance, 2014).
Theoretical health insurance literacy frameworks and organization-focused toolkits have
not been widely implemented in response to immediate marketplace and consumer enrollment
needs. Two more pragmatic approaches have emerged from Enroll America and the Centers for
Medicare and Medicaid that have been widely adopted by navigators and assisters an
increasingly by state-based marketplaces.
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“A Framework on Health Insurance Literacy for the Outreach and Enrollment
Community” (Stern, 2015) is the culmination of three years’ experience engaging low income,
culturally and linguistically diverse uninsured Americans to understand the marketplace
insurance plans. Their findings that “substantial gaps in knowledge about health insurance
remain, which may result in buyer’s remorse, improper utilization of health care services, and/or
loss of coverage completely” (Stern, 2015). Their five point framework: “1) understand
persistent consumer knowledge gaps, define what information consumers value, identify the best
time and manner to educate consumers, discover what triggers consumers’ need for new
information and determine what messengers consumers want to hear from” (Stern, 2015) is
person-centered and adaptable for use by clinical providers, enrollment assisters, brokers and
marketplace staff.
“From Coverage to Care” responds to health insurance literacy gaps with “an initiative,
developed by the Centers for Medicare & Medicaid Services (CMS), to help you understand
your health coverage and connect to primary care and the preventive services that are right for
you, so you can live a long and healthy life” (Centers for Medicare and Medicaid, 2016). CMS
has developed an 8-step roadmap used to teach consumers why health insurance is important,
terminology and financial concepts and responsibilities, and improves healthcare navigation
skills.
Problem Analysis
Health insurance marketplaces, community-based navigators and assisters, medical
providers and payers have a stake in successful implementation of the Affordable Care Act.
Research above summarizes the following problems in marketplace approaches to health
insurance literacy programs and services 1) Ineffective assumptions about newly enrolled adults
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and those who remain uninsured, 2) Lack of an evidence-based framework for program
development, 3) The need for organizations and their staff to become health literate.
Newly Insured Have Additional Sociocultural Barriers
Reports on ACA enrollment indicate that newly insured Americans are diverse in
language, ethnicity, income and literacy levels. Five in ten newly insured adults “were mostly
people of color and those who have a family income below 200% of the federal poverty level”
and people who have lived for longer periods “without having insurance” (Kaiser Family
Foundation, 2015). Research presented above shows that either many adults assume a better
understanding if health insurance concepts than they actually have or that they are avoiding
engagement in services to hide their lack of knowledge (Paez, Development of the Health
Insurance Literacy Measure: Conceptualizing and Measuring Consumer Ability to Choose and
Use Private Health Insurance, 2014). Poor health insurance literacy may be even more
pronounced among the elderly, low income and minority populations. Lack of a universally
accepted definition of health insurance literacy and framework for educating adults allows these
knowledge gaps to persist.
Lack of an Evidence-based Framework
Current health literacy focuses on a definition of the consumers’ ability to function in a
clinical or medical environment, an insufficient perspective that lacks integration of health
insurance concepts and consumer barriers. Traditional clinical framing care of health insurance
literacy perpetuates consumer knowledge gaps, providing few opportunities to increase their
knowledge. New frameworks based on research-based initiatives are effective tools to help
marketplaces evaluate current literacy engagement, products and services and address gaps.
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Promote a Health Literate Organization
After three years of ACA enrollment in the United States, health insurance marketplaces
have not become initiated organizational transformation to become more health literate,
effectively addressed the complexity of health insurance products, or provided navigators and
assisters with simplified tools to educate consumers on insurance financial concepts, terminology
or how to navigate the integrated environments of health and health insurance literacy. Recent
reports indicate that without significant changes, newly enrollment adults may experience gaps
in coverage, misuse of their insurance and lack of access to needed health services.
Possible Solutions
Health insurance marketplaces do not presently implement a comprehensive approach to
helping consumers to understand their insurance plans and use their plans to access healthcare
and improve their lives. However research included above identifies best practices rom several
different perspectives.
Adopt the Health Literacy Conceptual Model
This conceptual model establishes a clear definition and scope of work for health
insurance marketplaces and organizations to assess and understand the range of skills,
terminology and concepts required of consumers to enroll and use their health insurance.
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Based on an extensive literature review of previous health insurance literacy research, this model
was created with consumer and stakeholder input, and validated through data collection and
analysis.
Health Literacy Universal Precautions Toolkit
Health insurance marketplaces would benefit their consumers by adopting an
organizational-wide training in and implementation of the Universal Precautions Toolkit. This
toolkit empowers management to engage in continuous quality improvement across departments
by ensuring that all employees become health literate, integrate health literacy universal
precautions in their products and services and treat all consumers as if they require health
insurance literacy assistance. Organization-wide adoption of these strategies will create a more
equitable environment for elderly, low education and minority populations disproportionately
impacted by low health insurance literacy.
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Implement From Coverage to Care
Coverage to Care was developed by the Centers for Medicare and Medicaid Office of
Minority Health. From Coverage to Care is an initiative to help people with new health care
coverage understand their benefits and connect to primary care and the preventive services that
are right for them, so they can live a long and healthy life (Centers for Medicare and Medicaid,
2016).
The tool presented above, created as a summary expression and orientation of the
Coverage to Care Initiative is the “Road Map to Better Care and A Healthier You (Centers for
Medicare and Medicaid, 2016). The roadmap includes 8 steps which communicates what it
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means to have health insurance, when and where to seek health services, why prevention and
partnering with a provider is important for having the best health” (Centers for Medicare and
Medicaid, 2016). Information, terminology and skills are presented to help people “find and
schedule an appointment with a primary care provider, prepare for a primary care visit, and
determine if they have the right provider for their family” (Centers for Medicare and Medicaid,
2016).
Solution and Implementation
To achieve increased health insurance literacy among marketplace staff, enrollment
assisters and consumers, state-based marketplaces should implement From Coverage to Care.
Health insurance marketplace administrators, trainers and outreach coordinators can will impact
ACA health reform discussions, design and implementation of health insurance literacy
consumer engagement and education by incorporating the Paez health insurance literacy
framework (Paez, Development of the Health Insurance Literacy Measure: Conceptualizing and
Measuring Consumer Ability to Choose and Use Private Health Insurance, 2014) with From
Coverage to Care (C2C) initiative tools (Centers for Medicare and Medicaid, 2016).
Marketplaces should recruit and coordinate cross sector implementation teams including
private insurance payers, state-based Medicaid administrators, community-based navigators,
assisters and medical associations, doctors and other clinical providers in education and training
in the framework and C2C. Through this educational process, marketplaces will improve
stakeholders’ knowledge of consumer needs based on research – not assumptions – and explore
the intersection of health and health insurance literacy gaps expressed in the framework and
identified among American adults. During open enrollment, marketplaces can establish technical
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assistance programs for engaged stakeholders to help them develop policies and procedures that
are aligned with the framework and programs that incorporate the tools and skills building
concepts of C2C.
Learning objectives of training will include (1) increased knowledge of framework
concepts; (2) Understanding of C2C tools, why they are important for consumers to understand
and how to help consumers use them; (3) Understand of consumer health insurance literacy
knowledge gaps; (4) Skills on using the framework to develop person-centered policies across
the organizations and (5) Learn innovations to increase consumer health and health insurance
literacy, enrollment and health system navigation. Marketplace administrators and staff can
establish technical assistance services to support implementation of the framework and C2C.
One to one organizational consultation, webinars and regional meetings with stakeholders should
be a part of the implementation and technical assistance process to resolve immediate and
ongoing needs of medical providers, navigators and assisters, build organizational capacity and
“push” the best practice framework.
Issues that will persist during early implementation will include the need for funding and
organizational capacity building of stakeholders to achieve implementation of C2C and the
framework. Clinical providers may experience time barriers to use C2C with clients, navigators
and assisters may need ongoing training, funding support and deeper engagement of their
management and supervisors to incorporate the framework knowledge and use of C2C into their
normal enrollment activities. New trainings may have to be developed to address low literacy
and diverse language needs of consumers.
Effective implementation of these resources should be developed through person-
centered evaluations, surveys and focus groups that can be used to promote continuous quality
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improvement and organizational transformation in knowledge and skill to address health and
health insurance literacy gaps. C2C currently has not evaluation tools developed for its initiative,
however the framework developed by Paez et al was developed during research with consumers,
medical providers and enrollment assisters and can support evaluation tool development.
Long term process analysis should be established through the measurement of the
following lag and lead indicators:
Number of organizations/administrative leaders engaged in framework training and
implementation
Number of navigators, assisters and medical providers engaged in C2C training
Stakeholder increased knowledge, understanding and implementation capacity
Number of consumers touched by programs developed using C2C tools
Consumer feedback on sociocultural relevance, content and effectiveness to improve
their health and health insurance literacy and healthcare navigation skills
Justification
Health insurance marketplaces are the primary resource for American adults to access public
and private health insurance and enrollment assistance. While millions of adults have enrolled in
the last three years, research indicates that many newly enrolled and the remaining uninsured do
not have sufficient health and health insurance knowledge that they think they do, resulting in
poor utilization of insurance and healthcare services, unforeseen and costly financial
responsibilities and gaps in coverage. Marketplaces must take the lead in transforming their own
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organizational approaches and those of their stakeholders in understanding the real needs of
consumers and best practice frameworks and tools that address these complexities.
Increased health literacy among U.S. adult populations can be achieved through a person-
centered, population-level, health literacy education and skills building intervention. While
historical approaches to literacy are focused on a traditional clinical model and lack integration
of health and health insurance literacy, the framework develop by Paez et al is an evidence-based
approach that clearly identifies consumer knowledge gaps in insurance financial literacy,
navigation of health services and terminology used to maintain insurance and use it
appropriately.
Further, the framework helps to transition organizations to becoming health literate.
Organization-wide engagement in the framework as a quality improvement approach is a best
practice that engages managers, develops the enrollment assistance workforce and employees,
and “applies research-based tools which can result in better quality products and processes”
(Evans, 2012) in the marketplaces and among their stakeholder organizations. Successful ACA
implementation, enrollment of the uninsured and improved health insurance literacy among
American adults requires system-wide collaborative ownership (Centers for Medicare and
Medicaid, 2016). “The primary responsibility for improving health literacy lies with public
health professionals and the healthcare and public health systems. We must work together to
ensure that health information and services can be understood and used by all Americans. We
must engage in skill building with healthcare consumers and health professionals.” (Office of
Disease Prevention and Health Promotion, 2005)
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